Grace is a 10 year old Lab that I evaluated for mild elevation in hepatic enzyme numbers.
When I got to the R intercostal views in the SDEP protocol this large mass was seen. The liver was not involved
and no obvious reason for the hepatic enzyme elevation was noted and no hepatic biopsy was done. Adrenals looked OK.
I am posting this video. You can see the R kidney around 1-2 o’clock position. I just could not wrap my head around a renal carcinoma this size off the cranial pole of the kidney.
Grace is a 10 year old Lab that I evaluated for mild elevation in hepatic enzyme numbers.
When I got to the R intercostal views in the SDEP protocol this large mass was seen. The liver was not involved
and no obvious reason for the hepatic enzyme elevation was noted and no hepatic biopsy was done. Adrenals looked OK.
I am posting this video. You can see the R kidney around 1-2 o’clock position. I just could not wrap my head around a renal carcinoma this size off the cranial pole of the kidney.
Grace was reverred to Blue Pearl where Grace had this mass removed and the pathology was consistent with a renal carcinoma.
Comments
The key here is following the
The key here is following the lines and lack of them. As you see my mock up attached you can see the renal capsule around the mass (long arrow) and the renal capsule is a tough bugger it keeps everything in until the end so we can m,ake that work for us as clinical sonographers. Then as you move to the recognizable renal pelvis on the right and transition to the mass where there is no organ capsule separating the 2 (small arrow). If this were a liver mass you would see the renal capsule to the right of the mass and normal renal cortext between the capsule and renal pelvis. But in this case the pelvis blends into the mass wihtout separation as you go from right to left and then the capsule shows up containing the mass. This is a good thing because if no mets are present anywhere the capsule kept the pathology … well … encapsulated:) Hope this makes sense. It fits the curvilinear theory I lecture about if you recall Randy. Clincial sonography is about following the lines and then when and where they dissappear. Great question and cool case to show this
Thanks EL
Thanks EL